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Kaan Kirali
Tuncer Koçak
Füsun Güzelmeriç
Deniz Göksedef
Nihan Kayalar
Cevat Yakut
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Right arrow Coronary disease

Ann Thorac Surg 2004;78:1598-1602
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Off-Pump Awake Coronary Revascularization Using Bilateral Internal Thoracic Arteries

Kaan Kirali, MDa,*, Tuncer Koçak, MDb, Füsun Güzelmeriç, MDb, Deniz Göksedef, MDa, Nihan Kayalar, MDa, Cevat Yakut, MDa

a Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey
b Department of Cardiovascular Anesthesia, Kosuyolu Heart and Research Hospital, Istanbul, Turkey

Accepted for publication May 17, 2004.

* Address reprint requests to Dr Kirali, Department of Thoracic and Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, 81020 Kadiköy, Istanbul, Turkey
imkkirali{at}yahoo.com

BACKGROUND: A new technique has been developed that permits complete arterial revascularization of the lateral and/or inferior wall of the heart using in situ bilateral internal thoracic artery grafts in awake patients. This technique, without cardiopulmonary bypass and mechanical ventilation, creates the least invasive revascularization method for the lateral and/or posterior wall of the heart yet described.

METHODS: In 7 patients double or triple vessel coronary artery bypass grafting was performed without general anesthesia. A high thoracic epidural anesthesia was started one hour before surgery. Bilateral internal thoracic arteries were harvested and all anastomoses were performed with the off-pump technique by standard median sternotomy. Circumflex, or the right coronary artery, were anastomosed with bilateral internal thoracic arteries using a heart positioner. Six patients received double bypass grafting and one patient received triple bypass grafts (bilateral internal thoracic arteries and one radial artery).

RESULTS: All patients remained awake throughout the whole procedure. There was no perioperative myocardial infarction or mortality. Pneumothorax was observed in three patients, but it was repaired in two. Only one patient completed the procedure with unilateral pneumothorax. There were no hemodynamic and pulmonary problems during lateral or posterior wall revascularization. Two patients required unexpected coronary endarterectomy during circumflex and right coronary artery anastomoses.

CONCLUSIONS: Complete arterial revascularization by median sternotomy using in situ bilateral internal thoracic artery grafts without general anesthesia is a feasible and safe procedure for multivessel disease. This approach gives a chance for awake revascularization of the right and/or circumflex coronary artery.




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